Draft Medical Aid Regulations Could Mean Less Cover

August 18, 2015

South African patients’ rights groups are concerned that patients may be forced to cover the cost of certain treatments which are currently covered in full by their medical schemes. This follows the announcement of new draft medical aid regulations from the Department of Health recently concerning payment for PMBs (prescribed minimum benefits).

However, the director-general for the Health Department Dr. Anban Pillay tried to allay these fears, insisting that patients would not have to pay for PMBs. Currently the Medical Schemes Act requires medical schemes to pay for conditions listed under the PMBs in full.Strokes, viral meningitis and certain types of cancer are some of the 270 conditions and chronic diseases that are covered under PMBs.

Pillay says that the department’s aim in introducing the draft medical aid regulations was to try and ensure that patients don’t have to make additional payments on top of what their medical aid scheme pays out.

Aim of the Draft Medical Aid Regulations

They will help the schemes “…identify suppliers of service and structure that benefit such that when the patients go to these suppliers they will not need to make an additional out of pocket payment.”

However, the attorney for an NGO set up to protect the rights of medical scheme members has another view. He reads mischief into the government’s new proposed legislation.

The regulations will not alleviate the financial burden on policyholders. Attorney Umunyana Rugege says the new amendments will erode what little cover they currently enjoy. The current position at least guarantees patients some degree of access to healthcare. And this, he fears, may disappear.

The medical schemes are siding with the government. They feel that the new regulations will give them better sustainability. They believe they will mitigate the costs of funding treatment of PMBs.

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